People who sustain a traumatic event are suddenly critically ill. The complex care for this population is indeed complex and extends even beyond hospital discharge. Trauma, including burns, spans all ages, economic levels, and education levels. The manuscripts chosen for this issue address several aspects of managing the care of patients who suffer from traumatic or burn injury or who face complications of intensive care.

McGonigal begins the issue with an introduction to a subject that crosses all aspects of health care. Providers are often tasked with improving the quality of care within their practice settings by implementing a quality improvement project. McGonigal reviews each aspect of the 4 C model for quality improvement in her article, "Implementing a 4C Approach to Quality Improvement."

Following along from a quality improvement aspect, Hampe, Keeling, Fontana, and Balcik describe a project that developed an electronic documentation tool to accurately and efficiently evaluate documentation compliance of the health care staff. The outcomes of this project are reported in the article "Impacting Care and Treatment of the Burn Patient Conversion to Electronic Documentation." The results are outstanding and should inspire nurses who are considering launching a similar initiative.

In the article "Accurate Identification of Infection Source in Burn Trauma Patients With Central Line Catheter to Determine Appropriate Treatment Option As Well As Proper Public Reporting," Hampe, Graper, Hayes-Leight, Olszewski, Moffa, and Bremmer stress the importance of accurate and precise identification of primary and secondary infections in the burn-trauma patient.

In the article "Rib Fracture Protocol: Advancing the Care of the Elderly Patient," Leininger addresses a topic that is very relevant to the geriatric trauma population. The elderly patient older than 65 years is at high risk for rib fractures due to falls, even from a standing position as well as from heights such as climbing a ladder. Leininger's article describes the process of implementing a change by revising protocols for trauma evaluation and subsequent management of elderly patients who have sustained injuries that could impact the rib cage.

Callister describes the care of patients in long-term acute care (LTAC) settings in his article "The Hospital Course of a Successfully Treated Respiratory Failure Patient-Beginning to End!" After hospitalization, many people cannot return to their place of residency. Because of the extent of injury along with comorbidities, patients may need further care and rehabilitation. This article describes the capabilities and the role of the postdischarge LTAC in returning people to their optimal level of functioning posttrauma.

Mowry's contribution, "Case Study: OB Trauma With Maternal Death and Fetal Survival," discusses the topic of trauma in the obstetric population that is the leading cause of non-obstetric-related maternal and fetal death. The article reviews obstetric physiology, assessment, and treatment and also details a case of blunt force trauma in this vulnerable population and details how one hospital system manages obstetric injuries.

In the article "Best Practice for Pressure Ulcer Prevention in the Burn Center," Warner, Raible, Hajduk, and Collavo report the findings of a program aimed at reducing the development of pressure ulcers in the burn patient. The article describes the unique aspects of these coexisting morbidities and outlines steps in a collaborative effort to improve outcomes in this population.

Bires, Leonard, and Thurber describe the results of a study that was conducted to compare a provider's awareness and comfort level with "return to play" guidelines. In the article "Provider Education on Postconcussion Guidelines," the authors also discuss the secondary aim of the study that was to evaluate current protocols for "return to play."

Opening a new hospital invariably poses many logistical problems for intensive care unit (ICU) staff and their patients. Comeau, Armendariz-Batiste, and Baer discuss one hospital's approach to adapting to a new environment, revised workflow processes, and new equipment. The article "Preparing ICU and Medical-Surgical Nurses to Open a New Hospital" provides valuable insights into ensuring patient safety and staff sanity during the multifaceted transitions associated with the move day.

The final contribution is not necessarily associated with the burn and trauma but considers an important issue for all nurses who must manage complex seizure disorders. The treatment of status epilepticus is complicated and approximately one-third of patients do not respond to the first-line agents such as benzodiazepines and other antiseizure medications. Authors Wiss, Samarin, Marler, and Jones review the literature and discuss novel approaches for the management of this complex clinical problem. "Continuous Infusion Antiepileptic Medications for Refractory Status Epilepticus-A Review for Nurses" should be required reading for all ICU nurses.

We hope you enjoy this issue of Critical Care Nursing Quarterly and that the author's insights will inspire you to reevaluate your practices.

-Katrina A. Pyo, PhD, RN, CCRN

-Lori Laux, MSN, RN-BC, CRNP

Issue Editors